RN Case Manager - FT Day

Thomas Jefferson University • Philadelphia, PA

2d • Onsite

About The Position

The Case Manager RN utilizes advanced nursing skills and knowledge to comprehensively coordinate care for a defined patient population to facilitate patients through the continuum of care. Coordinates all aspects of discharge planning and establishes a safe discharge plan for assigned patients.

Requirements

• Advanced nursing skills and knowledge
• RN license
• Case management or discharge planning experience
• Effective use of conflict resolution skills
• Efficient prioritization and time management skills

Nice To Haves

• Applies specific relevant medical necessity criteria for all patients to determine the appropriate patient status or continued need for hospital level of care (Center City).
• Documents appropriate medical necessity criteria level of care guidelines subset (InterQual)(Center City).
• Follows departmental procedures for Condition 44 downgrades, including medical record documentation, and informing patient and relevant department staff.
• Adheres to organizational policies and procedures, identified third party payer contract utilization management workflows and governmental payer processes.
• Applies initial DRG for all inpatients and document in the Care Advance (applicable hospitals).
• Completes an initial assessment to assess patient’s needs and resources for discharge planning.
• Establishes discharge plan including homecare services, transportation, post-acute facility placements.
• Ensures all Post-Acute authorizations are secured for patients discharge.
• Precept and mentor new staff members to their role and department.
• Meets with patient/family to assess needs to complete an initial Case Management Assessment per Department policy and procedure, then develops an initial discharge plan.
• Refers appropriate cases for Social Work intervention and involvement.
• Documents all relevant information in the Medical Record according to Department policies and procedures.
• Delivers the MOON to observation status patients within the required timeframe (Center City).
• Ensures appropriate patients receive the second copy of the CMS IM within 2 days of discharge (Center City).
• Facilitates patient transfers to other acute care hospitals.
• Communicates with identified Department staff to initiate and facilitate referrals and authorizations for post-acute care services and any medical necessity issues.
• Refers cases and identified issues to the Physician Advisor in compliance with departmental procedures.

Responsibilities

• Interacts with co-workers, visitors, and other staff consistent with the values of Jefferson.
• Advocates for the patient and family throughout the entire episode of care.
• Functions as a resource to facilitate communication among the healthcare team and patient/family.
• Facilitates patient progression throughout the patient’s hospital stay.
• Reviews patient length of stay/barriers data to facilitate patients’ progression during Multidisciplinary Rounds and Escalation/Outlier meetings.
• Reviews patients’ status daily to identify issues requiring priority interventions or attention which may impact the established discharge plan.
• May facilitate daily patient Plan of Care Huddle Rounds functioning as the Patient Progression Leader or supports the identified Patient Progression Leader.
• Monitors patient’s progress intervening as necessary to ensure patient progresses efficiently.
• Proactively identifies and resolves barriers to patient care and/or progression to discharge.
• Escalates unresolved barriers to Department Leadership.
• Applies specific relevant medical necessity criteria for all patients to determine the appropriate patient status or continued need for hospital level of care (Center City).
• Documents appropriate medical necessity criteria level of care guidelines subset (InterQual)(Center City).
• Follows departmental procedures for Condition 44 downgrades, including medical record documentation, and informing patient and relevant department staff.
• Adheres to organizational policies and procedures, identified third party payer contract utilization management workflows and governmental payer processes.
• Applies initial DRG for all inpatients and document in the Care Advance (applicable hospitals).
• Completes an initial assessment to assess patient’s needs and resources for discharge planning.
• Establishes discharge plan including homecare services, transportation, post-acute facility placements.
• Ensures all Post-Acute authorizations are secured for patients discharge.
• Precept and mentor new staff members to their role and department.
• Meets with patient/family to assess needs to complete an initial Case Management Assessment per Department policy and procedure, then develops an initial discharge plan.
• Refers appropriate cases for Social Work intervention and involvement.
• Documents all relevant information in the Medical Record according to Department policies and procedures.
• Delivers the MOON to observation status patients within the required timeframe (Center City).
• Ensures appropriate patients receive the second copy of the CMS IM within 2 days of discharge (Center City).
• Facilitates patient transfers to other acute care hospitals.
• Communicates with identified Department staff to initiate and facilitate referrals and authorizations for post-acute care services and any medical necessity issues.
• Refers cases and identified issues to the Physician Advisor in compliance with departmental procedures.

Benefits

• Medical (including prescription)
• Supplemental insurance
• Dental
• Vision
• Life and AD&D insurance
• Short- and long-term disability
• Flexible spending accounts
• Retirement plans
• Tuition assistance
• Voluntary benefits
• Tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level